Objective: This study was conducted to investigate the relationship between hip bone mineral density (BMD), fat free mass (FFM), fat mass (FM), and total body mass (TBM) and the extent to which these relationships were modified by various confounding factors. The cross-sectional analysis included 262 healthy females (mean age 41.6±3.0 years). Methods: BMD of the hip and body composition were assessed by the Hologic 4500W dual energy x-ray absorptiometry (DXA) system. Total and intensity of physical activity (PA) were objectively measured using an Actigraph accelerometer. Dietary calcium and vitamin D from food and beverages, as well as from supplements, were measured separately using the Block food frequency questionnaire. Menopause status and prescription bone drug use were measured by a questionnaire. Results: The relationship between FFM and hip BMD was strong and robust (F=24.5, P<0.0001). Using the pooled standard deviation revealed a large effect size of 1.2 when comparing hip BMD of women with low FFM and high FFM. Potentially confounding variables, considered individually and collectively, did not change this relationship. The association between FM and hip BMD was also substantial (F=9.9, P<0.0001) and remained significant when controlling for all potentially confounding variables, except differences in FFM. The relationship between TBM and hip BMD was also strong and dose-response (F=21.5, P<0.0001) and remained significant, except when differences in FFM were controlled. Conclusion: The relationships between body mass (total, fat, and fat free) and BMD of the hip in middle-age women are strong and significant. The associations are not influenced by differences in age, height, menopause status, calcium or vitamin D intake, volume or intensity of PA, or the use of bone enhancing prescription drugs. The findings suggest that women with low body mass, particularly low FFM, tend to have low hip BMD and there is little that can be done to change this association.



College and Department

Life Sciences; Exercise Sciences



Date Submitted


Document Type





osteoporosis, body composition, cross-sectional, DXA, calcium, vitamin D, premenopausal